Sports Surgery Clinic Podcast Sports Surgery Clinic

Welcome to 'On the Table' - Sports Surgery Clinic's orthopaedic advances podcast hosted by Dr Andy Franklyn-Miller, Consultant Sports & Exercise Medicine Physician at SSC.

The purpose of the podcast is to explore the reasons behind making a decision to operate in common orthopaedic conditions and explore the latest evidence and post-operative strategies.

In Episode Seven, we are delighted to speak to Mr Michael Kelleher Consultant Neurosurgeon and Mr Eoin Fenton Consultant Neurosurgeon at Sports Surgery Clinic.

This episode focuses on the topic of back pain and the management of radiculopathy and leg referral of pain and what to watch out for in cauda equina.

Shownotes:
04:14
Back pain is an incredibly common condition with huge morbidity caused with both time off in from work, lack of activity and pain, can you talk us through some of the epidemiology?
05:35
Can you talk us through some of the anatomical features in the back which can be associated with injury and pain?
08:15
How important is imaging of the spine in helping the patient and making the diagnosis?
12:20
Hesitancy and asymptomatic prevalence in MRI, how does use the scan to support the understanding rather than head to surgery?
14:40
The importance of strength and conditioning in back pain?
15:30
How long can rehabilitation of the back take?
16:16
If the patient cannot tolerate a strength intervention due to radiculopathy, what next?
18:50
What types of guided injection can be of help in a patient with pain and what are the differences between transiting and exiting nerve roots?
22:00
When is the indication to progress to consider microdisc surgery?
23:13
What actually happens in a microdiscetomy, and what differs when you have bony overgrowth from the facet joint?
24:30
What does the post-operative management look like?
27:00
If there was a recurrence of symptoms after surgery what options remain? And what are the risks of surgery?
29:04
What is Cauda equina syndrome, and what do we do?
32:00
How important is patient understanding in terminology?
33:00
Is digital rectal examination still important for rectal tone?

Neurospine Contact Details:

Suite: 10 Sports Surgery Clinic, Santry, Dublin 9.
Phone: +353 1 526 2227
Fax: +353 1 526 2232
Email: info@neurospine.ie

Welcome to 'On the Table' - Sports Surgery Clinic's orthopaedic advances podcast hosted by Dr Andy Franklyn-Miller, Consultant Sports & Exercise Medicine Physician at SSC.

The purpose of the podcast is to explore the reasons behind making a decision to operate in common orthopaedic conditions and explore the latest evidence and post-operative strategies.

In Episode Eight, we are delighted to speak to Mr Ray Moran, Consultant Orthopaedic Surgeon and Medical Director at Sports Surgery Clinic.

This episode focuses on the topic of decision making around the Anterior Cruciate Ligament (ACL), the evolving techniques into ACL graft selection and the rehabilitation and post-operative management and Ray's latest paper on ACL outcomes.

Shownotes:

O4:15
What is an ACL ligament?

06:28
Can you talk me through the decision making regarding surgical repair with the patient?

08:29
What about the debate on conservative non-operative management of ACL rupture?

10:20
How important is a timeline for the patient?

12:24
The outcome of your recent paper in AJSM shows a very low re-injury rate in a big series?

14:20
What are the critical time points postoperatively in management?

16:53
The paper showed that bone patellar bone was prefered for a lower re-injury rate, but the Hamstring graft did ok, too, what makes that decision?

21:01
There is always a new version of the operation, the Australians suggested using Kangaroo tail, we went through a phase of LARS repair, and the follow up suggested these really were not that good, but they are reappearing and now the Quad tendon repair - why the continual quest to change?

24.40
Bertrand Sonnery-Cottet from Lyon has published some work on assisted ligament repair of proximal ACL's is this something that might come to SSC in the future?

27:40
How important is graft tension to a successful outcome?

29:22
Biomechanical analysis has led to a low re-injury rate, how important is this and if re-injury does occur what then?


Papers mentioned in the podcast

Factors Influencing Return to Play and Second Anterior Cruciate LigamentInjury Rates in Level 1 Athletes After Primary Anterior Cruciate LigamentReconstruction: 2-Year Follow-up on 1432 Reconstructions at a Single Center.
King E, Richter C, Jackson M, Franklyn-Miller A, Falvey E, Myer GD, Strike S, Withers D, Moran R.Am J Sports Med. 2020 Mar;48(4):812-824.

ACL or ACL.
Reider B.Am J Sports Med. 2020 Feb;48(2):281-284.

ACL rupture in the immediate build-up to the Olympic Games: return to elite alpine ski competition 5 months after injury and ACL repair.
Praz C, Kandhari VK, Saithna A, Sonnery-Cottet B.BMJ Case Rep. 2019 Mar 15;12(3):e227735.


Mr Ray Moran's rooms are located in Suite 5 at the Sports Surgery Clinic in Santry.

Welcome to 'On the Table' - Sports Surgery Clinic's orthopaedic advances podcast hosted by Dr Andy Franklyn-Miller, Consultant Sports & Exercise Medicine Physician at SSC.

The purpose of the podcast is to explore the reasons behind making a decision to operate in common orthopaedic conditions and explore the latest evidence and post-operative strategies.

In Episode Six, we are delighted to speak to Miss Ann-Maria Byrne, Consultant Orthopaedic Surgeon at the Sports Surgery Clinic and specialist in elbow, hand and wrist surgery.

This episode focuses on the topic of decision making around the biceps and common extensor origin injuries and surgical indications.

Shownotes:

5:09
Distal biceps ruptures certainly seem to be increasingly common, anecdotally one always thinks anabolic steroid use, but the mechanism is more varied?

8:10
Is there commonly tendinopathy or avulsion?

11:38
What is the mechanism of injury in rupture?

13:04
How do you go about the clinical assessment is this something you use to differentiate between partial and complete tears? What are the decision making steps in deciding to operate?16:58
Does MRI help or hinder decision making?

18:38
What does biceps surgery involve?

23:12
And what does the post-operative period look like?

27:17
When can they lift heavy again?

29:09
What are the complications of surgery

32:02
When does contact sport come back?

33:51
Common Extensor Origin tendinopathy, what does the evidence suggest?

37:41
What are the differential diagnosis before surgery?

44:52
When can surgery assist?

45:22
Matache published a protocol for a sham RCT of arthroscopic release using DASH (Disability of Shoulder and Hand) and Mayo Elbow Performance Score (MEPS) not all our listeners will be familiar with DASH and MEPS are these well accepted PROMS that can use to track improvement?


Papers mentioned in the podcast

Platelet-Rich-Plasma Injections in Treating Lateral Epicondylosis: a Review of the Recent Evidence.
Murray DJ, Javed S, Jain N, Kemp S, Watts AC.
J Hand Microsurg. 2015 Dec;7(2):320-5. doi: 10.1007/s12593-015-0193-3. Epub 2015 Jul 8. Review.

Matache BA, Berdusco R, Momoli F, Lapner PL, Pollock JW. A randomized, double-blind sham-controlled trial on the efficacy of arthroscopic tennis elbow release for the management of chronic lateral epicondylitis. BMC Musculoskelet Disord. 2016;17:239. Published 2016 Jun 1. doi:10.1186/s12891-016-1093-9

Ms Ann-Maria Byrne's clinic is based in Sports Surgery Clinic's Northwood Suite in Santry.

Her secretary is Niamh Kennedy
Phone: +353 1 5262345
Email:ambyrneadmin@sportssurgeryclinic.com